Provider Demographics
NPI:1598200776
Name:HODGES, OLISHA (LCSW)
Entity Type:Individual
Prefix:
First Name:OLISHA
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 TOWER ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402
Mailing Address - Country:US
Mailing Address - Phone:650-312-5221
Mailing Address - Fax:650-572-2414
Practice Address - Street 1:31 TOWER ROAD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402
Practice Address - Country:US
Practice Address - Phone:650-312-5221
Practice Address - Fax:650-572-2414
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA750261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical